DETROIT — More than 300,000 doses of COVID-19 vaccines are on the verge of expiring in Michigan as demand for shots wane right as the state stares down what appears to be a fourth surge of cases.
The Michigan Department of Health and Human Services estimates that about 161,000 doses of the Johnson & Johnson vaccine and between 143,000 and 146,000 doses of the Moderna vaccine expire near the end of this month, said Lynn Sutfin, a spokeswoman for the health department.
Eighteen months into the pandemic, 1 in 10 Michiganians have tested positive for COVID-19. One in 485 have died. And for months now, the number of people getting first doses of a vaccine has been dropping to a trickle.
The number of shots getting into people’s arms has been below 100,000 since the weekend of June 26, down from an April peak of 679,409 doses administered. Excluding this week, for which numbers are not yet completed, providers have been administering an average of 70,000 doses a week for three months, according to state data.
"The urgency and fear is just not there as much as it was in the first few weeks of vaccinations being broadly available," said Dr. Asha Shajahan, medical director of community health for Beaumont Grosse Pointe. "But it is the same virus as it was when we had shutdowns and businesses were closed. You can still get really sick, especially with the variants."
Data provided by MDHHS indicates as many as 27,000 vaccine doses may have already expired in the state, although Sutfin was not able to provide an exact number. Expired doses are disposed of as medical waste. Another nearly 196,000 were drawn from vials — each vial has multiple doses — but ultimately not used.
If kept in the right conditions, the Moderna vaccine can last about six months, as does the Johnson & Johnson vaccine. The Food and Drug Administration last month extended the shelf life of the Pfizer vaccine from six months to nine.
Meanwhile, the number of vaccines delivered to providers peaked at 906,360 doses the week of April 10 but also has since fallen off, state data shows. That number plummeted to fewer than 100,000 doses a week from mid-June to mid-July and has never been more than a third of the spring weekly peak since.
In total, 13.1 million vaccine doses have been delivered to providers in Michigan, and about 9.8 million have been administered, according to state data.
Michigan is not alone in seeing the number of people getting vaccinations slow from springtime highs, when people who were eager for shots were crowding pharmacies and mass vaccination sites like Detroit’s Ford Field and TCF Center.
Fear about the delta variant led to a small bump in July, matching national trends, and amid news that the FDA officially approved the Pfizer vaccine on Aug. 23, there was another increase.
But since the first week in July, Michigan has seen some of the smallest percent increases in the percent of total population with at least one dose in the country, according to the federal Centers for Disease Control and Prevention, behind just Vermont and West Virginia.
Vaccines help limit spread of virus
A Detroit News analysis comparing the most vaccinated counties in the state against some of the least shows fewer people are getting sick where vaccines are more prominent, even when adjusted for population differences.
Take Leelanau County in the northwestern corner of the lower peninsula, which state data indicates is the most vaccinated in the state. There, 80% of people eligible for vaccinations have gotten at least one shot, according to state data, making it the most vaccinated county in the state. The county went almost the entire month of June without a new confirmed case of COVID-19, and in the time since, even as case rates have begun to rise in other parts of the state, rates in Leelanau have stayed relatively low.
Dr. Joshua Meyerson, the medical director for the Benzie-Leelanau District Health Department and the four counties covered in the Health Department of Northwest Michigan, said that part of what worked in Leelanau County to get people vaccinated was that it was small and many people knew each other.
In Hillsdale County, the number of confirmed cases has been consistently higher than in Leelanau, even when taking the population difference into account. Hillsdale is one of the least vaccinated counties in the state. There, 42.2% of all eligible people have gotten at least one dose, state data shows.
There are a few different factors contributing to that, said Rebecca Burns, a public health officer for Branch, Hillsdale and St. Joseph counties.
Hillsdale borders both Ohio and Indiana, so it's possible people got vaccinated in either of those states and didn’t report the data to Michigan. The Amish population in the area is also often hesitant to get vaccinated, Burns said, which can bring down the total vaccination rate.
Regardless of the reason, the area has a lower reported vaccination rate than other places in the state. Burns said that contributed to the higher case rate in the area, especially when compared to more vaccinated areas.
"At the beginning, we were so excited when the vaccines started to flow in our counties. There was such a demand initially that we couldn't get it to everyone who wanted it," Burns said. "People were extremely angry they couldn't get it. Now, we're in a place where we have more vaccine than we can reasonably give away."
Even Michigan’s largest counties are seeing the same pattern: A higher percentage of people with at least one dose has generally meant that the number of people with confirmed illnesses is smaller.
Of the three largest counties in Michigan — Wayne, Oakland and Macomb — Oakland has the highest vaccination rate with about 72.45% of all eligible adults getting at least one shot as of Sept. 20, according to state data. Oakland County also generally has maintained a lower number of confirmed cases per thousand people than other counties, a News analysis found.
That trend doesn't always strictly hold though. Wayne County has 60.16% of people with at least one dose, but a lower case rate than Macomb County, which has 61.5% of people with at least one dose. Wayne County's overall vaccination rate is brought down significantly by low vaccination in Detroit, where state data shows only about 40.7% of people are vaccinated.
"We're seeing this a lot. It does seem to be tracking that where the risk is the highest is where vaccination rates are lower," Burns said.
That could be dangerous for all Michiganians. The CDC rates almost the entire state as having "high" risk of COVID transmission and advises everyone in Michigan to wear masks indoors in public spaces. Medical experts and health officials have been warning people for months that without an increase in vaccination, the state could be facing a new wave of COVID-related illness and death.
The delta variant is believed to be twice as contagious as other variants seen so far.In states with low vaccination rates, delta has been particularly harmful. States including Mississippi, Arkansas and Louisiana saw huge increases in vaccine rates after the delta variant battered residents and strained medical care.
In Idaho, the least vaccinated state in the country, according to CDC data, the entire state is under last-resort crisis standards of care — meaning hospitals, strained from an immense number of COVID-19 patients in addition to those coming to the hospital for other needs, must triage patients. Beds are limited, and some types of care are rationed or delayed. Similar standards are being implemented in parts of Alaska and Montana.
“By delaying getting your vaccinations, more variants can emerge like the delta variant,” Shajahan said. “This is a worldwide problem. That choice isn’t just affecting Michigan or your city. It’s affecting everyone.”
Breaking through vaccine hesitancy
Even with many counties opening vaccine clinics to the public nearly daily, it can be hard to get people in who have not already gotten at least one shot.
At a clinic put on by the Wayne County Health Department in Livonia on Thursday, most attendees were there for third doses rather than first ones.
About 50,000 people had gotten third doses as of last week, Sutfin said. In the coming months, millions more could be getting booster shots across the country after CDC advisers said Pfizer boosters should be offered to those 65 and older and anyone 50 or older with underlying health problems that could put them at greater risk. The third dose would be offered at least six months after a person's last Pfizer dose.
Beth Bunn, a therapist and social worker, was one person getting her third dose in Livonia on Thursday. The room was almost empty, which she said was a stark difference from the big groups she saw when she got her first dose. In her work, she said, she sees people who feel strongly that everyone should get it and others who are adamant they won't.
"As a result, we've been doing a lot of telehealth, just for everyone's safety and comfort," she said.
As a therapist, she works with clients to figure out what their individual feelings are on vaccinations. She tries to "squash anything that we know for sure is a conspiracy," but ultimately, the decision is up to each person.
It's a stark difference from the conversations about the vaccine she has with her mom, who is 72 and lives in Georgia. Bunn's mother is against the vaccine, she said.
"I have to take off my therapy hat and tell her very much how I feel about it, how she needs to get vaccinated soon or else you're going to die," Bunn said. "I say, 'It's not worth losing you.'"
Health experts say they've heard a variety of reasons why people may not want to get the vaccine. Misinformation looms large in many people's minds about everything from side effects about the vaccines (millions of people around the world have gotten it, and only few have faced serious side effects) to how it affects fertility (there is no evidence it does, but studies are ongoing) to what the risk of getting sick may be (which can vary widely from person to person even in the same age range or general state of health).
"It's certainly frustrating that people don't want to get it, but we have a vaccine we know works," Burns said. "We're not going to give up on the population. We're going to keep doing everything we can to encourage people to get this vaccine because it is safe and it can protect them."
The most important thing for health leaders, though, continues to be answering people's questions honestly and providing them with accurate information. Shajahan, who is also the graduate medical education director of social equity and health disparities at Beaumont Health, has worked extensively on finding ways to talk to people who are hesitant about vaccines.
She has found virtual town hall-style events, where multiple people can get their questions answered at once without fear of sounding silly in public, can be a way to share information with a larger group. Conversations that feel one-on-one, even if they're in a larger group setting, can make a difference.
Shajahan advises those looking to talk to unvaccinated loved ones not to approach the conversation as a competition or an argument, but to instead focus on creating a space to hear that person out and not judge.
"You're not going to debunk every single myth, but what you can do is ask them, 'What would it take for you to get vaccinated?'" she said. "Then listen to their thoughts and reasons."
Pointing people to good sources that haven't been politicized, such as resources from the University of Michigan, the Cleveland Clinic or Johns Hopkins University, can help. It can also help for a person to talk one-on-one with a doctor who shares some sort of commonality, including race or both having children.
Shajahan then will give people time to look at new information and revisit the conversation later. When the goal is a compassionate conversation focused on empowering people to make up their own minds, she said, it can make a huge difference.
“You can cause harm to other people if you’re not vaccinated, not only to yourself but also other people,” she said. “I think people realizing that can make a big difference.”
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